COVID COVID-19 Coronavirus Containment Efforts

[atyy]

I don't think the evidence supports that. The media played-up busy hospitals and harried staff, but NYC added substantial emergency capacity, which went almost completely unused.
https://www.navytimes.com/news/your...s-nyc-having-treated-fewer-than-200-patients/

https://www.google.com/amp/s/abc7ny.com/amp/coronavirus-nyc-update-corona-virus-cases/6142109/

https://www.militarytimes.com/news/...orkers-are-going-straight-into-nyc-hospitals/

Your links don't support that hospitals were not overwhelmed. The extra personnel were used, and some extra capacity was used.

https://www.militarytimes.com/news/...orkers-are-going-straight-into-nyc-hospitals/
"About 200 doctors, nurses, respiratory therapists and others are working in New York’s medical centers, where bed space has not been overwhelmed, but where hospital-acquired Coronavirus cases have sidelined civilian staff. "

https://www.navytimes.com/news/your...s-nyc-having-treated-fewer-than-200-patients/
"The Javits Center, which was initially envisioned as a 2,500-bed field hospital for non-COVID patients, converted to coronavirus-only hospital shortly after going operational. Still, the highest number of patients treated at the convention center at one time topped out at close to 500."

Another piece of evidence that the hospital system was stretched is that some instituted ventilator sharing, which is not usual practice. https://www.nbcnewyork.com/news/cor...to-buy-time-for-coronavirus-patients/2363049/

 

[russ_watters]

Your links don't support that hospitals were not overwhelmed. The extra personnel were used, and some extra capacity was used.

Well not for nothing, but your first link explicitly states that the hospitals were not overwhelmed.

Using some of the emergency capacity doesn't mean all the hospitals totally filled-up first. My understanding is the emergency capacity was for non-COVID patients or those who were convalescing after they were out of the woods. It's part of a re-shuffling of resources designed in part to prevent future capacity issues (along with cancelling regular appointments and non-emergency surgeries). Here's a more specific article on the subject:
https://www.propublica.org/article/how-americas-hospitals-survived-the-first-wave-of-the-coronavirus

“We have 53,000 hospital beds available,” Cuomo, a Democrat, said at a briefing on March 22. “Right now, the curve suggests we could need 110,000 hospital beds...”

...But when New York hit its peak in early April, fewer than 19,000 people were hospitalized with COVID-19.

It's fair to say resources (in particular, personnel) were stretched, a small number of hospitals filled to capacity and that there were specific shortages of materials and equipment, but "overwhelmed" has a much worse connotation than that -- a connotation that is necessary to support the argument that a substantially higher death rate occurred because of hospital capacity issues. E.G., you cited a 5x higher IFR in Hubei as an example. You can't get a 5x higher IFR due to "overwhelmed" hospitals without at least a system-wide 80% shortfall in critical needs. Sharing ventilators isn't enough: you'd need to be rationing them to every 5th person who needs them. Or have a smaller overage that causes a systemic collapse. But NYC was nowhere close to full capacity overall.

And the article provides a specific reason that the projections were wrong -- it's the issue we're discussing: the disease is/was nowhere near as severe as the early projections. From the article, it says the CDC initially estimated 11 hospitalizations would be needed per death, then later dropped it to 7, then later to 4. This is almost certainly the same as the CFR issue; the disease is less severe than initially thought because the testing shortage meant we were missing most of the people infected. This almost certainly affected Hubei as well. There may also have been political approach factors at play (e.g., if they quarantined every infected person at field hospitals instead of letting them quarantine at home), but I'm not sure of the details of that.

New York's early testing rate was way low. At their peak in early April they had a 50% positivity rate. Their testing rate was many, many times lower than it should have been and they almost certainly missed the large majority of their infected:
https://coronavirus.jhu.edu/testing/individual-states/new-york
Beginning of April ~20,000 tests per day and 50% positive.

 

[atyy]

It's fair to say resources (in particular, personnel) were stretched, a small number of hospitals filled to capacity and that there were specific shortages of materials and equipment, but "overwhelmed" has a much worse connotation than that -- a connotation that is necessary to support the argument that a substantially higher death rate occurred because of hospital capacity issues. E.G., you cited a 5x higher IFR in Hubei as an example. You can't get a 5x higher IFR due to "overwhelmed" hospitals without at least a system-wide 80% shortfall in critical needs. Sharing ventilators isn't enough: you'd need to be rationing them to every 5th person who needs them. Or have a smaller overage that causes a systemic collapse. But NYC was nowhere close to full capacity overall.

And the article provides a specific reason that the projections were wrong -- it's the issue we're discussing: the disease is/was nowhere near as severe as the early projections. From the article, it says the CDC initially estimated 11 hospitalizations would be needed per death, then later dropped it to 7, then later to 4. This is almost certainly the same as the CFR issue; the disease is less severe than initially thought because the testing shortage meant we were missing most of the people infected. This almost certainly affected Hubei as well. There may also have been political approach factors at play (e.g., if they quarantined every infected person at field hospitals instead of letting them quarantine at home), but I'm not sure of the details of that.

Yes, "stretched" is a better word. And definitely it is a matter of conjecture, whether stretched hospital care contributes to explaining why the IFR in NYC could have been higher than 0.3% in the early phases of the outbreak. Even in Hubei, the 5X is a CFR, not IFR, so after adjustments for different methods of counting cases, it may translate into only a small difference in IFR between Hubei and other parts of China, and the uncertainties are consistent with no difference (https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30243-7/fulltext).

Interestingly, in Wuhan, it does seem that the extra hospital capacity was used: https://www.reuters.com/article/us-health-coronavirus-china-toll-idUSKBN20P01K.

 

[mfb]

the disease is/was nowhere near as severe as the early projections. From the article, it says the CDC initially estimated 11 hospitalizations would be needed per death, then later dropped it to 7, then later to 4.

The CDC initially estimated a 9% fatality rate for hospitalized cases then updated that to 14%, then to 25%, and that's less severe than the 9%?

 

[russ_watters]

The CDC initially estimated a 9% fatality rate for hospitalized cases then updated that to 14%, then to 25%, and that's less severe than the 9%?

I suppose if you ignore the dropping per case death rate that could be confusing. The entire line has stretched, and the death count is the anchor: we were missing most of the less intense cases. As the pandemic has progressed and the testing rate has increased we have seen fewer hospitalizations and many fewer deaths per case than was initially expected. I really don't understand why people seem to be pretending that the case rates in March/April were accurate and misconstruing the resulting shift in the statistics. Are you expecting an explosion of deaths in Germany in the next few weeks due to the increasing case rate there? Germany peaked around 5,000 cases per day and 200 deaths per day (average over about a week - guestimated) in the spring. Now in the second peak it is seeing around 2,000 cases and 10 deaths per day. Are you expecting the death rate to increase by a factor of 4 in the near future? I don't; I expect that like most other countries, the early severity of the virus (in terms of hospitalizations and deaths) was overestimated due to the low testing rates for people with milder symptoms.

 

[russ_watters]

Yes, "stretched" is a better word. And definitely it is a matter of conjecture, whether stretched hospital care contributes to explaining why the IFR in NYC could have been higher than 0.3% in the early phases of the outbreak.

IMO, it shouldn't be controversial. When the testing rate is known to be extremely low, it shouldn't be controversial that it plays a bigger role in the statistics than a "stretched" medical system.

I really find this truly bizarre that you (not the specific "you", but the general) are trying to stretch a few percent here or there into hundreds of percent. We don't know if single digit, dozens or hundreds of people overall died because they shared ventilators, but we do know that millions of people who should have been tested in New York, alone, were not. Over the past month, the US media anyway has been breathlessly reporting the record daily case rates, without ever reporting (that I have seen) that those case rates are offset by a factor of 5 or 10 from those in March/April due to the higher testing rate.

 

[Rive]

...the disease is less severe than initially thought because the testing shortage meant we were missing most of the people infected.

That does not fit well with the result of some studies from spring where whole societies (!) were tested. Those studies were the ones which established the whole 'half the infected are without symptoms' thing.

BTW is there any studies already about the 'CFR per age group' kind of statistics from summer? I would like to see some.
Without the 'age group' part raw CFR or IFR does not really worth anything.
At least I think so.

 

[atyy]

IMO, it shouldn't be controversial. When the testing rate is known to be extremely low, it shouldn't be controversial that it plays a bigger role in the statistics than a "stretched" medical system.

I really find this truly bizarre that you (not the specific "you", but the general) are trying to stretch a few percent here or there into hundreds of percent. We don't know if single digit, dozens or hundreds of people overall died because they shared ventilators, but we do know that millions of people who should have been tested in New York, alone, were not. Over the past month, the US media anyway has been breathlessly reporting the record daily case rates, without ever reporting (that I have seen) that those case rates are offset by a factor of 5 or 10 from those in March/April due to the higher testing rate.

Let's say 4 people in 1000 die if everyone that dies needs a ventilator and has to share (ie. sharing ventilators is ineffective), and 2 people in 1000 die if everyone who needs a ventilator gets their own (ventilators save 50% of those who need one). Then one would get a 100% increase in fatality rate (from 2/1000 to 4/1000), even taking into account that many do not get tested.

 

[russ_watters]

Let's say 4 people in 1000 die if everyone that dies needs a ventilator and has to share (ie. sharing ventilators is ineffective), and 2 people in 1000 die if everyone who needs a ventilator gets their own (ventilators save 50% of those who need one). Then one would get a 100% increase in fatality rate (from 2/1000 to 4/1000), even taking into account that many do not get tested.

Right, that's my point: we didn't have a 100% ventilator shortage. Ventilator sharing happened, but it wasn't common, much less universal.

 

[mfb]

@Russ: No one questions that many cases were missed in March and April. That's not what the discussion was about. Cases that go to a hospital are severe cases, they are not missed. If these people die more often than estimated before, how is that change in particular making the disease less dangerous? You cited that change as evidence that the danger was overestimated.
If you argue people got less likely to be admitted to a hospital than before - while the disease stays unchanged - that would mean hospitals had to turn down increasingly severe cases. That would mean they are overwhelmed. I don't say that's true, but that's one of the few ways to interpret these numbers without saying it kills more people than expected before.

 

[morrobay]

From the article, it says the CDC initially estimated 11 hospitalizations would be needed per death, then later dropped it to 7, then later to 4. This is almost certainly the same as the CFR issue; the disease is less severe than initially thought because the testing shortage meant we were missing most of the people infected.

And the CDC initially estimated the fatality rate for hospital cases was 9% then 14 % then 25%. So there are two tracks here. The hospitalizations / fatality has dropped with a corresponding increase in fatality rate/hospitalizations. And mutually inclusive the disease is less severe because the testing shortage was missing large numbers of mild/asymptomatic people.

 

[russ_watters]

@Russ: No one questions that many cases were missed in March and April. That's not what the discussion was about. Cases that go to a hospital are severe cases, they are not missed. If these people die more often than estimated before, how is that change in particular making the disease less dangerous? You cited that change as evidence that the danger was overestimated.

Ok, yeah, I see how the data/model can be interpreted from either direction if we don't have the context/method. FYI, I didn't make this interpretation up myself, I read it in the news/commentary article. But now I checked the original source to make sure that the direction the article specified is correct, and yes, it is correct: fewer hospitalizations per death means fewer hospitalizations, not more deaths. Deaths is the anchor, hospitalizations the variable, so when the fraction decreases its because hospitalizations decreased, not because deaths increased:

[page 5]
Why did these changes occur?

These changes in predicted hospital resource use and related gaps in states where demand might exceed supply are fairly large. In this section, we explore the changes in our analytical framework that resulted in these revised estimates of overall lower hospital resource use due to COVID-19.

...our overall ratio was 11.1 hospital admissions per COVID-19 death.

...Our estimates released today... 7.1 hospitalizations per death (95% CI 4.0 to 12.7). These lower ratios of admissions to deaths result in predicted peak hospital resource use – total beds, ICU beds, and invasive ventilators – that is lower than previously estimated.
[emphasis added]

http://www.healthdata.org/sites/default/files/files/Projects/COVID/Estimation_update_040520_3.pdf

If you argue people got less likely to be admitted to a hospital than before - while the disease stays unchanged - that would mean hospitals had to turn down increasingly severe cases. That would mean they are overwhelmed. I don't say that's true, but that's one of the few ways to interpret these numbers without saying it kills more people than expected before.
[emphasis added]

Since you already know it that it is in fact false, I don't understand why you are even offering it as a possibility. Please stop trying to use this inaccurate claim as a basis for your interpretation of the data, and instead follow the data where it actually leads. Again, I really don't understand why this should be controversial.

The options I see are:
1. The disease is more severe than previously thought, so the "cone" of infected, hospitalized, dead is steeper.
2. The disease is less severe than previously thought, so fewer people need to be hospitalized based on adjusted criteria on if/when to admit them.
3. The disease itself has changed.
4. Demographics issues (old vs young people) caused the change.

#1 was covered in the first section; not the case.
#2 seems plausible due to the early chaos and learning curve.
#3 is possible but harder to be sure of.
#4 seems plausible due to the known demographics shift in the infected.

 

[atyy]

http://www.healthdata.org/sites/default/files/files/Projects/COVID/Estimation_update_040520_3.pdf

For New York, by deaths per day (p10), the CDCs later estimates (April 2 & 5) seem to have been more severe than initially estimated (March 26).

 

[russ_watters]

For New York, by deaths per day (p10), the CDCs later estimates (April 2 & 5) seem to have been more severe than initially estimated (March 26).

Yes.

 

[atyy]

Yes.

Also, I guess these are IHME's estimates, not the CDC's?

 

[russ_watters]

Also, I guess these are IHME's estimates, not the CDC's?

Yes, apologies, you are correct: the first number (11.1) was direct from CDC data whereas the second (7.1) is from the expanded study/data set from IHME. The news article lists a third ("about 4") that is also presumably from IHME, but it doesn't have a link to it. It also mentions a Harvard model that also estimated too high.

 

[atyy]

Yes, apologies, you are correct: the first number (11.1) was direct from CDC data whereas the second (7.1) is from the expanded study/data set from IHME. The news article lists a third ("about 4") that is also presumably from IHME, but it doesn't have a link to it. It also mentions a Harvard model that also estimated too high.

I guess the uncertainties are tricky to estimate. In the deaths per day estimates of the IHME's report, the uncertainties go to zero as the predicted deaths goes to zero in around June, whereas one might think that since those points are furthest from the then existing data, the uncertainties should be larger later in time. On the other hand, if the main model was China, COVID-19 deaths there do seem to have gone to zero for the moment.

 

[Vanadium 50]

0.10% of the population died in Manaus. Some parts of NYC had more deaths. It's possible that the official number underestimates the total deaths of course.

Ever been to Manaus? It is incredibly isolated. Everything goes in and out by air - there is a little river traffic (but it's over a thousand miles from the ocean) and one road north and one road south, neither of which is passable in the rainy season. It's like an island, surrounded by vegetation and not ocean.

 

[mfb]

Since you already know it that it is in fact false, I don't understand why you are even offering it as a possibility. Please stop trying to use this inaccurate claim as a basis for your interpretation of the data, and instead follow the data where it actually leads. Again, I really don't understand why this should be controversial.

"I don't say that's true" doesn't mean its false. I listed it as one possible interpretation of the data.

#1 was covered in the first section; not the case.

I don't see how you can rule this out, because hospitalized -> death did get steeper based on CDC/IHME estimates. Your own source demonstrates that #1 is the case for at least half of that chain.

I don't see how deaths could be any reasonable anchor. Infections would be the best, in the absence of reliable infection numbers we can use hospitalizations (limiting the analysis to cases that are not mild). But starting from deaths is weird. Going by that definition a disease that puts 1% into a hospital but only kills 0.001% must be the worst disease ever? 1000 hospitalizations per death! In addition hospitalizations per death go up if treatment in a hospital gets better (i.e. the hospital gets better in preventing deaths) - which certainly means the disease gets less dangerous, not more dangerous.

Ever been to Manaus?

No, but I'm not sure what the conclusion of your post is.

 

[Vanadium 50]

No conclusion at all, other than Manaus was an outlier long before Covid. There is no place quite like it anywhere.

 

[Astronuc]

NY Times is attempting to track COVID-19 cases at US universities and colleges.
https://www.nytimes.com/interactive/2020/us/covid-college-cases-tracker.html

A New York Times survey of more than 1,600 American colleges and universities — including every four-year public institution and every private college that competes in N.C.A.A. sports — has revealed at least 130,000 cases and at least 70 deaths since the pandemic began.

In a related articles, the NY Times reports on a seemingly very healthy, i.e., athletic and no apparent pre-existing condition (co-morbidity), 19-year-old "College Student Dies of Rare Covid-19 Complications"
https://www.nytimes.com/2020/09/29/us/college-student-dies-covid.html

He tested positive for the Coronavirus on Sept. 7 and quarantined for 10 days before returning to Boone, according to his uncle. Then he got worse, after he seemingly recovered well enough to return to his apartment near school. He was removed from life support by his parents on Sept 28. According to his uncle, "it was not clear how his nephew had contracted the virus. “He told us he was always careful to wear a mask.” " A family friend who taught Chad Dorrill in high school, said doctors told the family that they suspected he had a previously undetected case of Guillain-Barré syndrome, a rare neurological disorder in which the body’s immune system attacks nerves. So, it seems possible that he did have an undiagnosed condition.

 

[russ_watters]

"I don't say that's true" doesn't mean its false. I listed it as one possible interpretation of the data.

I don't see how you can rule this out, because hospitalized -> death did get steeper based on CDC/IHME estimates. Your own source demonstrates that #1 is the case for at least half of that chain.

*I* am saying it's false and I'm saying that you should understand/accept by now that it is false because we just discussed it in some detail. It's fine to follow a chain of logic to find "possible" interpretations, but then you have to start analyzing them and checking against other facts to verify if they are in fact true, false or actually unknown/possible. This one has been determined to be false, so it should be taken off the list, not continued to be listed as "possible".

I don't see how deaths could be any reasonable anchor. Infections would be the best, [snip] But starting from deaths is weird.

I agree that starting from deaths does feel weird, but as you pointed out previously, deaths are a solidly known number. So that make them a good, perhaps the best anchor. It's best to rely on the facts we have for an anchor, agreed? That's why, somewhat separately, we are starting from death #s and projecting infected #s. The death numbers are known to be more reliable.

in the absence of reliable infection numbers we can use hospitalizations (limiting the analysis to cases that are not mild).

Hospitalizations are the output of the model, so they can't be an input.

I feel like you may have lost track of what we were discussing. I entered the latest chain on Sunday to contradict the common claim that hospitals were overwhelmed (potentially driving a higher death rate). I presented data that shows they weren't, models that shows they were predicted to be, and data that explains the disconnect. You're still saying it is "possible" that's all backwards. It's not.

Going by that definition a disease that puts 1% into a hospital but only kills 0.001% must be the worst disease ever? 1000 hospitalizations per death! In addition hospitalizations per death go up if treatment in a hospital gets better (i.e. the hospital gets better in preventing deaths) - which certainly means the disease gets less dangerous, not more dangerous.

A disease that puts 1% into the hospital and kills 0.001% is worse than a disease that puts 0.1% into the hospital and kills 0.001%. Same number dead, more hospitalized is "worse". Or even worse, if having 1% in the hospital increases the death rate to 0.002% due to hospitals being "overwhelmed". That's the claim/prediction, I entered to counter. Here it is again:

Overall an IFR of 1% may be a bit high, but given that the NYC health system was overwhelmed in the early stages, it seems plausible that IFR in the early stages of the NYC outbreak was higher

We should all agree/accept by now that the "given" premise is false, not "possible" and therefore it could not have driven the conclusion to be true.
[edit] ...which doesn't mean the conclusion about the IFR couldn't be true for other reasons. It may well be true due to demographics (old people were practically targeted for infection).

 

[mfb]

I agree that starting from deaths does feel weird, but as you pointed out previously, deaths are a solidly known number.

Hospitalizations are known as well. Maybe even better, because they don't include deaths for unknown reasons outside hospitals. Being solidly known alone doesn't make something a good anchor.

Hospitalizations are the output of the model, so they can't be an input.

Past hospitalizations and deaths are known and can be inputs (if it's an output, then you better check it's correct), future hospitalizations and deaths (the reason you make a model) can be an output but not an input.

I feel like you may have lost track of what we were discussing.

I was commenting on a very specific claim - that more deaths per hospitalization would mean the disease is less severe. I said this is not the case. I made a small side remark how you could get more deaths per hospitalization without a more severe disease (overcrowded hospitals), and I said this was largely a theoretical option without much relevance. I think you missed that part, because you keep going back to that side remark as if it would have been something important. It wasn't. Forget it.
If more people who go to a hospital die that's bad.

A disease that puts 1% into the hospital and kills 0.001% is worse than a disease that puts 0.1% into the hospital and kills 0.001%. Same number dead, more hospitalized is "worse".

But how realistic is this comparison? hospital->death ratio depends on how severe the disease is in cases that we can count easily. Why would cases that we can't study easily behave in exactly the opposite way? A disease that puts more people into a hospital than a comparable disease will almost certainly kill more people, too.----

The sum of official death tolls exceeded 1 million two days ago.

 

[atyy]

We should all agree/accept by now that the "given" premise is false, not "possible" and therefore it could not have driven the conclusion to be true.
[edit] ...which doesn't mean the conclusion about the IFR couldn't be true for other reasons. It may well be true due to demographics (old people were practically targeted for infection).

I still wouldn't agree that you have ruled it out (although I agree remains conjecture), since we do agree that the health system was stretched. In my ventilator sharing example, your objection to that as a possible contributing factor is that only a small fraction of patients shared ventilators. But you can imagine other possibilities, For example, suppose it takes an hour a day to optimize ventilator settings per patient, but due to the huge caseload, there is only 20 minutes a day for adjusting ventilator settings, that could also lead to worse outcomes.

For example, early reports about death rates for those on ventilators were higher than this later report. The authors discuss "Several local and regional considerations may have influenced the observed outcomes. First, the arrival and peak of the COVID-19 pandemic in Georgia were later than in many of the regions from earlier reports. This delay provided time to establish organizational structures, acquire equipment, prepare personnel, create consensus-driven clinical protocols, and align resources across a large healthcare system. In addition, while patient volumes did merit the redesignation of several specialty ICUs as COVID-ICUs, all critically ill patients with COVID-19 were admitted to preexisting ICUs and cared for by critical care teams with experience managing acute respiratory failure and at standard patient-to-provider ratios."
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7255393/
https://news.emory.edu/stories/2020/05/coronavirus_emory_icu_outcomes/index.html

 

[Astronuc]

Meanwhile in NY, the Dept of Health continues to "aggressively track clusters with a particular focus on the 20 ZIP codes with the highest infection rates. Within these 20 "hotspot" ZIP codes, the average infection rate is 5.5 percent. The rate of infection for the rest of New York State, excluding those 20 ZIP codes, is 0.82 percent. While these 20 ZIP codes accounted for almost a quarter of yesterday's positive cases, they represent only 6 percent of the state's population." - from an email alert from the Governor's office.

By zip code: Rockland County (10952, 10977), Brooklyn (11230, 11204, 11219, 11223, 11229, 11210, 11234), the Bronx (10465, 10462), Manhattan (10040), Queens (11374), Staten Island (10306, 10304), Suffolk County (11717, 11746) and Nassau County (11580).

https://www.governor.ny.gov/news/go...h-community-leaders-address-covid-19-clusters

 

[StevieTNZ]

Confirmed Donald Trump has COVID-19.

https://www.stuff.co.nz/world/ameri...ne-process-and-tests-positive-for-coronavirus

 

[mfb]

Please keep our rules about political discussions in mind. Posting the news is fine - and it's certainly a high profile news.

Here is CNN's article - I guess every larger news outlet has an article or will have it soon.

 

[Astronuc]

I read an article that mentioned the surveillance testing at the White House uses the Abbott rapid test.

Apparently Trump advisor, Hope Hicks, began showing symptoms Wednesday evening and subsequently tested positive for COVID-19. Donald and Melania Trump were tested Thursday, and he may be experiencing mild symptoms at present.

 

[Vanadium 50]

Abbott rapid test

Which is important, as that test determines whether or not the subject has the virus right now, as opposed to an antibody test which determines if the subject ever had it.

 

[StevieTNZ]

https://www.newshub.co.nz/home/worl...ised-after-being-diagnosed-with-covid-19.html

US President Donald Trump is on his way to military hospital Walter Reed Medical Centre, White House Press Secretary reports.
"The President will be working from the presidential offices at Walter Reed for the next few days," White House Press Secretary Kayleigh McEnany said in a statement on Saturday.
Trump has had a fever since Saturday morning, according to CNN.
McEnany said this was "out of an abundance of caution, and at the recommendation of his physician and medical experts."

 

[mfb]

Trump has had a fever since Saturday morning, according to CNN.

I assume this is Saturday morning New Zealand time, i.e. now, not nearly a week ago.

 

[StevieTNZ]

I assume this is Saturday morning New Zealand time, i.e. now, not nearly a week ago.

I would think so.

 

[Astronuc]

Trump has had a fever since Saturday morning, according to CNN.

I read a short message attributed to the NY Times that Trump had a fever, congestion and cough, as of some time today (Friday in US). Hope Hicks was 'not feeling well' 48 hours ago, so she was already infectious.

 

[StevieTNZ]

Ardern had asked for New Zealand's representatives in the United States to pass on the message wishing the president a "speedy recovery".

She had previously personally messaged UK Prime Minister Boris Johnson when he contracted Covid-19 earlier in the year, but that was because she had his phone number. As you could expect, Ardern said, it would not be common for people to have the personal number of the US President -- and she didn't.

"We've used our official channels to pass on that message."

and

Asked about the possible implications for New Zealand, such a disruption to the US presidency could have, Ardern said it was "too early to say".

"We still haven't even seen out of the administration the likely effect they believe it will have on the election campaign. Of course, we haven't seen an election date moved before [in the US] and it's quite a process for that to happen.

"So at this stage, I'd say it would all be highly speculative we just haven't heard anything official from the White House in that regard."

-- https://www.stuff.co.nz/national/po...ent-donald-trump-first-lady-a-speedy-recovery

 

[Astronuc]

According to CNN,

Shortly before midnight, the President's physician, Navy Cmdr. Dr. Sean Conley finally gave an update on the President's condition, saying in a memo that the President is "doing very well" and has not required any supplemental oxygen, but that doctors have initiated the antiviral drug remdesivir, which has been shown to shorten recovery time for some Coronavirus patients.

https://www.cnn.com/2020/10/03/politics/donald-trump-coronavirus-walter-reed/index.html

Melania Trump remained at the White House with what the White House physician described as a mild cough and a headache.

Meanwhile, Former White House counselor Kellyanne Conway said Friday night that she has tested positive for coronavirus, and Trump's campaign manager Bill Stepien has tested positive for coronavirus, who expressed 'mild flu-like symptoms.' Three journalists who work at the White House tested positive on Friday, according to a series of memos from the White House Correspondents Association.

Update: Three US Senators, Mike Lee (R - Utah), Thom Tillis (R - North Carolina) and now Ron Johnson (R-Wisconsin). Johnson had quarantined for two weeks after exposure to someone who tested positive, he was again exposed to Coronavirus after his quarantine ended and he returned to Washington!

Cleveland (Politico) - Eleven new cases of Covid-19 were reported in Cleveland stemming from the presidential debate held in the city this week, the city government disclosed Friday.

 

[Dale]

Frequent testing is clearly not a viable substitute for social distancing and PPE usage

 

[BillTre]

Its my understanding from news reports that even though they had the resources for frequent testing, they failed to make use of those opportunities.
In addition to their other failings with with distancing and PPE.

Not taking it seriously.
Discouraging others in their circle from taking precautions.

 

[Ygggdrasil]

According to CNN,

Shortly before midnight, the President's physician, Navy Cmdr. Dr. Sean Conley finally gave an update on the President's condition, saying in a memo that the President is "doing very well" and has not required any supplemental oxygen, but that doctors have initiated the antiviral drug remdesivir, which has been shown to shorten recovery time for some Coronavirus patients.

https://www.cnn.com/2020/10/03/politics/donald-trump-coronavirus-walter-reed/index.html

Many news outlets are also reporting that the President has been given an experimental monoclonal antibody cocktail currently in testing as a potential COVID-19 therapy:

Trump received a single 8 gram dose of Regeneron's dual antibody cocktail Friday and completed the infusion without incident, the President's physician, Dr. Sean Conley, said in a statement.

"In addition to the polyclonal antibodies, the President has been taking zinc, vitamin D, famotidine, melatonin and a daily aspirin," Conley said.

https://www.cnn.com/2020/10/02/health/trump-regeneron-antibody-treatment/index.html

Frequent testing is clearly not a viable substitute for social distancing and PPE usage

This is also apparent from outbreaks that have occurred the among the Tennessee Titans NFL team (which has forced the league to postpone the team's game this weekend). The team has seen a Coronavirus outbreak spread to six players and seven team personnel despite testing all players and personnel six days a week.

 

[Astronuc]

Many news outlets are also reporting that the President has been given an experimental monoclonal antibody cocktail currently in testing as a potential COVID-19 therapy:

Yes, apparently it's two monoclonal antibody compounds, which were administered at the White House. Remdesivir was started at the hospital as a prophylactic, and treatment will continue over 5 days. The president seems to have responded as he apparently has no fever and is without need of supplemental oxygen (his oxygen levels are good).

About Regeneron's treatment
https://www.sciencemag.org/news/2020/09/provocative-results-boost-hopes-antibody-treatment-covid-19
https://science.sciencemag.org/content/369/6506/1014.abstract

 

[Ygggdrasil]

Remdesivir was started at the hospital as a prophylactic

It's not a prophylactic if he is already is infected with the virus.

Experience with other antivirals (such as tamiflu) suggests that these types of treatments are more likely to be effective at preventing severe symptoms if administered early in the course of the disease.

 

[Astronuc]

It's not a prophylactic if he is already is infected with the virus.

Experience with other antivirals (such as tamiflu) suggests that these types of treatments are more likely to be effective at preventing severe symptoms if administered early in the course of the disease.

I heard an interview today that used the term prophylactic with respect to Remdesivir, since it was started early, and the use was intended to prevent worsening of the infection. Apparently, in earlier patients, it was tried once they were on a ventilator, as was the case in one of the earliest infections in New Jersey. Perhaps, it took so long to get a dose approved. I believe Remdesivir was rationed to the worst cases.

 

[Ygggdrasil]

I heard an interview today that used the term prophylactic with respect to Remdesivir, since it was started early, and the use was intended to prevent worsening of the infection. Apparently, in earlier patients, it was tried once they were on a ventilator, as was the case in one of the earliest infections in New Jersey. Perhaps, it took so long to get a dose approved. I believe Remdesivir was rationed to the worst cases.

A prophylactic drug would be given to healthy individuals to prevent them from being infected with the disease (e.g. pre-exposure prophylaxis [PrEP] for HIV). For example, see this page about using tamiflu for treatment vs prophylaxis:

Q. What do the terms treatment of the flu and prevention (prophylaxis) of the flu mean?
A. Treatment is used when a person is given Tamiflu because they have the signs and symptoms of the flu or have been diagnosed with the flu. Tamiflu has been shown to lessen the amount of time people are sick with the flu.

Prevention (prophylaxis) is a term used when someone who does not have flu symptoms is given Tamiflu to help stop them from getting the flu because they are exposed to or come into close contact with someone (for example live with or take care of someone) who has the flu.

https://www.fda.gov/drugs/postmarke...viders/tamiflu-consumer-questions-and-answers

Treatment with antiviral drugs should generally be started early in order to prevent worsening of the infection. For example, Tamiflu, an antiviral drug from the Influenza virus, is effective at decreasing the duration and severity of illness, but only if taken within 36-48 hours of the onset of symptoms.

"One of the problems is that Tamiflu is seen by the public as a drug that will save you from all cases of the flu," he says. "Tamiflu can decrease the duration of illness by 30% to 40%, and decrease flu severity by about 40% -- but only if taken in the first 36 to 48 hours of illness. And you know that will not happen all the time."

https://www.webmd.com/cold-and-flu/news/20121114/does-tamiflu-work-questions-continue

For clinical trials of Remdesivir, it is true that the drug has generally been given only to severe cases, though this is likely due to limited availability of the drug and it's method of administration (it can only be delivered intravenously and not orally).

 

[Evo]

Interesting, I've read this elsewhere.

Updated at 4:55 p.m. ET

President Trump tweeted early Friday morning that he tested positive for the coronavirus. But questions remain about what exactly happened before and after — when the president was first diagnosed, started experiencing symptoms and what treatment he received and when.

On Saturday, for example, White House physician Sean Conley told reporters Trump was "72 hours" into his diagnosis, but later said in a memo later on that he meant to say Day 3. Conley refused to say whether Trump had ever received supplemental oxygen this week, and another doctor said Trump received treatment 48 hours ago — also quickly walked back by the White House.

Good information

https://www.npr.org/sections/latest...e-know-of-president-trumps-covid-19-diagnosis

 

[StevieTNZ]

Also this:

US President Donald Trump went through a “very concerning” period and the next 48 hours will be critical in terms of his care as he battles the Coronavirus at a military hospital, White House chief of staff Mark Meadows has said.

The comments came after it was revealed that Trump was administered supplemental oxygen on Friday morning (local time) at the White House before he was transported to the hospital, although staff insisted he had only mild symptoms.
...
According to a person familiar with Trump’s condition, Trump was administered oxygen at the White House on Friday before he was transported to the military hospital. The person was not authorised to speak publicly and spoke to The Associated Press on condition of anonymity.

-- https://www.stuff.co.nz/world/ameri...er-very-concerning-period-in-coronavirus-care

 

[Vanadium 50]

I am so old I remember when anonymous sources required confirmation. This is how we get Kim Jong-Un dying in April. And again in August.

I'm also so old I remember when news organizations did not leak medical information to the press. (In this case, not just the President's, but also Hope Hicks').

 

[mfb]

Conflicting reports raise concerns about severity of Trump's Covid condition

The source of the graver prognosis was subsequently identified as Mark Meadows, the White House chief of staff, who was observed talking to the reporters and was recorded on camera asking for his comments to be “off the record”, although he has not confirmed this.

 

[jim mcnamara]

@Vanadium 50 So you remember Woodrow Wilson's wife, Edith - who essentially ran the country while WW was incapacitated by a stroke for last years of his term?

https://en.wikipedia.org/wiki/Edith_Wilson

Apparently, she and some inner circle advisers managed to keep WW's actual very poor health a secret. From 1919 until the end of his term in 1921.

 

[StevieTNZ]

US President Donald Trump has released a new hospital video in which he says he's starting to feel better and hopes to “be back soon”.
In the four-minute video posted to Twitter, Trump says he “wasn't feeling so well” when he was admitted to Walter Reed National Military Medical Center after testing positive for the coronavirus.

...

The Trumps diagnosis joins a growing number of other Republican figures who have also tested positive, most recently including former New Jersey Governor Chris Christie, who helped Trump prepare for last week’s debate with former Vice President Joe Biden.

Other prominent people within Trump’s circle who have also tested positive include his campaign manager Bill Stepien and his former advisor Kellyanne Conway.

-- https://www.stuff.co.nz/world/ameri...rom-military-hospital-after-covid19-diagnosis

 

[Vanadium 50]

So you remember Woodrow Wilson's wife, Edith

I'm not that old.

But I do know the story.

 

[Astronuc]

For clinical trials of Remdesivir, it is true that the drug has generally been given only to severe cases, though this is likely due to limited availability of the drug and it's method of administration (it can only be delivered intravenously and not orally).

Back in March, that was the situation, and supplies were extremely limited, and trials had only just begun. Enrollment for Adaptive Covid-19 Treatment Trial (ACTT-1) began on February 21, 2020, and ended on April 19, 2020.

https://www.nejm.org/doi/full/10.1056/NEJMoa2007764